#{extends 'main.html' /} #{form @Application.confirm()}
<div class="row-fluid">

	<div class="span6 offset1">
		<div class="hero-unit">
			<h2>Account Information</h2>
			<hr>
			<div id="confirmAddress">
				<h3>Confirm Address</h3>
				<label for="name">Name:</label> <input id="name" name="name" /> <label
					for="lname">Last name:</label> <input id="lname" name="lname" /> <label
					for="address">Address:</label> <input id="address"
					value="${address}" name="address" /> <label for="tel">Telephone:</label>
				<input id="tel" name="address" /> <label for="email">Email:</label>
				<input id="email" name="email" />
			</div>
			<hr>
			<div id="paymentMethod">
				<h3>Payment details</h3>
				<label for="visa">VISA</label> <input type="radio" name="payOption"
					id="visa" value="visa"><br> <label for="cash">Cash</label>
				<input type="radio" name="payOption" id="cash" value="cash"
					checked="true"><br>
			</div>
			<hr>
			<div class= "pull-right">
				<input class="btn btn-small btn-primary" type="submit"
					value="Check out" />
			</div>
		</div>
	</div>
</div>
#{/form}
